Does Spontanious Continue to Go Up

Spontaneous abortion is pregnancy loss before 20 weeks gestation. Threatened abortion is vaginal bleeding without cervical dilation before 20 weeks in a confirmed viable intrauterine pregnancy. Diagnosis is by pelvic examination, measurement of beta subunit of human chorionic gonadotropin, and ultrasonography. Treatment is usually expectant observation for threatened abortion and, if spontaneous abortion has occurred or appears unavoidable, observation or uterine evacuation.

Spontaneous abortion, by definition, is death of the fetus. About 20 to 30% of women with confirmed pregnancies bleed during the first 20 weeks of pregnancy; half of these women spontaneously abort. Thus, incidence of spontaneous abortion is up to about 20% in confirmed pregnancies. Incidence in all pregnancies is probably higher because some very early abortions are mistaken for a late menstrual period.

Fetal death and early delivery are classified as follows:

• Spontaneous abortion: Death of the fetus, sometimes with passage of products of conception (fetus and placenta), before 20 weeks gestation

• Early or late

• Threatened or inevitable

• Incomplete or complete

• Missed

• 1. Magnus MC, Wilcox AJ, Morken NH, et al: Role of maternal age and pregnancy history in risk of miscarriage: Prospective register based study. BMJ 364:l869, 2019. doi: 10.1136/bmj.l869

Risk factors for spontaneous abortion include

• Age > 35

• History of spontaneous abortion

Subclinical thyroid disorders, a retroverted uterus, and minor trauma have not been shown to cause spontaneous abortions.

Symptoms and Signs of Spontaneous Abortion

Symptoms of spontaneous abortion include crampy pelvic pain, uterine bleeding, and eventually expulsion of tissue. Late spontaneous abortion may begin with a gush of fluid when the membranes rupture. Hemorrhage is rarely massive. A dilated cervix indicates that abortion is inevitable.

• Usually ultrasonography and quantitative beta subunit of human chorionic gonadotropin (beta-hCG)

• Pelvic examination

Pregnancy is diagnosed with a urine or blood beta-hCG test. Ultrasonography is done to confirm intrauterine pregnancy and check for fetal cardiac activity, which is usually detectable after 5.5 to 6 weeks gestation. However, gestational age is often somewhat uncertain, and serial ultrasonography may be required. If cardiac activity is absent and had been detected previously during this pregnancy, fetal death is diagnosed. Alternatively, serial beta-hCG levels that decrease across ≤ 3 measurements are consistent with a failed pregnancy.

Assessment is also done to determine the status of the abortion process as follows:

• Threatened abortion: Patients have uterine bleeding and it is too early to assess whether the fetus is alive and viable and the cervix is closed. Potentially, the pregnancy may continue without complications.

• Inevitable abortion: The cervix is dilated. If the cervix is dilated, the volume of bleeding should be evaluated because it is sometimes significant.

• Incomplete abortion: The products of conception are partially expelled.

Missed abortion is suspected if the uterus does not progressively enlarge or if quantitative beta-hCG is low for gestational age or does not double within 48 to 72 hours. Missed abortion is confirmed if ultrasonography shows any of the following:

• Disappearance of previously detected embryonic cardiac activity

• Absence of such activity when the fetal crown-rump length is > 7 mm

• Absence of a fetal pole (determined by transvaginal ultrasonography) when the mean sac diameter (average of diameters measured in 3 orthogonal planes) is > 25 mm

An anembryonic pregnancy refers to a gestational sac with no yolk sac or embryo, seen on ultrasound, in a nonviable pregnancy.

• For threatened abortion, observation

• For inevitable, incomplete, or missed abortions, observation or surgical or medical uterine evacuation

• If the mother is Rh-negative, Rho(D) immune globulin

• Sometimes pain medication

• Emotional support

For threatened abortion, treatment is observation, but health care practitioners may periodically evaluate the woman's symptoms or do ultrasonography. No evidence suggests that bed rest decreases risk of subsequent completed abortion.

For inevitable, incomplete, or missed abortions, treatment is uterine evacuation or waiting for spontaneous passage of the products of conception. For patients managed expectantly, evacuation is done if excessive bleeding or infection occur or if the products of conception do not pass after about 2 to 4 weeks.

If complete abortion is suspected, uterine evacuation is not done routinely. Uterine evacuation can be done if bleeding occurs and/or if other signs indicate that products of conception may be retained.

After a spontaneous abortion, parents may feel grief or guilt. They should be given emotional support and, in most cases of spontaneous abortions, reassured that their actions were not the cause. Formal counseling or support groups may be made available if appropriate.

• Spontaneous abortion is pregnancy loss before 20 weeks gestation; it probably occurs in up to 20% of pregnancies.

• Spontaneous abortion is often caused by chromosomal abnormalities or maternal reproductive tract abnormalities (eg, bicornuate uterus, fibroids), but etiology in an individual case is usually not confirmed.

• Confirm spontaneous abortion and determine pregnancy status with quantitative beta-hCG, ultrasonography, and pelvic examination; a dilated cervix means that abortion is inevitable.

• Treat with expectant management (observe for passage of products of conception) or surgical or medication (with misoprostol or sometimes mifepristone) uterine evacuation.

• Often, uterine evacuation is not needed for threatened and complete abortions.

• Provide emotional support to the parents.

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Source: https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/spontaneous-abortion

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